NPI 1861311573

Jerardy Ivan Velasquez-Bravo

Practitioner Dental Assistant Fort Polk, LA

Practice location

Address: 6180 University Pkwy Unit 3905, Fort Polk, LA 71459-3118
Phone: (757) 709-5503

Registered specialties

Dental Assistant Primary

Dental Providers Taxonomy 126800000X

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Registry record

NPI: 1861311573
Entity type: Individual
Sex (as registered): Male
NPI issued: 15 Jul 2026
Record last updated: 15 Jul 2026

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.